Impact of Academic Detailing in the Chicagoland Region: A Pilot Study A. Simon Pickard, PhD Todd A. Lee, PharmD, PhD

Academic Detailing Focused on one-on-one educational outreach Provides evidence-based information Effective at modifying behavior Prescribing antihypertensives Prescribing antimicrobials Alcohol use disorder treatment HIV testing Prevention for States activities Increased use of academic detailing Strategy for modifying prescribing behavior

Study Aims STUDY AIMS Primary aim To determine the feasibility and impact of academic detailing visits on opioid prescribing activities among PCPs from a large health system in the Chicagoland-area Secondary aims To explore PCPs experience and satisfaction with academic detailing visits Identify potential barriers and factors for success of academic detailing visits Measure quality of interaction based on perception of academic detailers

PICOTS Framework PICOTS FRAMEWORK POPULATION Primary care providers (PCPs) from a large health system in the Chicagoland area (AMITA Health) INTERVENTION Academic detailing visits focused on past prescribing and CDC Guidelines for Prescribing Opioids for Chronic Pain COMPARATOR Group of non-AMITA primary care physicians in the Chicagoland area OUTCOMES Measures of opioid prescribing TIMEFRAME May – August 2018 SETTING PCP practice locations in the Chicagoland area (AMITA Health and control sites)

Study Design Quasi-experimental study Pre/post assessment of opioid prescribing indicators Prescribing measures 6 months before intervention and 6 months after intervention Measures in both intervention and control groups Difference-in-difference approach to evaluate the effectiveness of the intervention

Intervention Group AMITA Health primary care providers Around 300 eligible PCPs Licensed healthcare professional with prescriptive authority (MD, DO, NP, PA) Excluding residents from intervention due to timing

Comparison Group Randomly selected group of non-AMITA PCPs in the Chicagoland area Matching at the zip code level and provider type Unknowns / Issues – Within organization interventions Constrain comparison group to another health system

Intervention Two academic detailing visits by trained academic detailers Visits will be 15-30 minute face-to-face encounters Visits will include following elements Greetings/introductions Review of PCPs opioid prescribing metrics (“dashboard” metrics) Key aspects of CDC Guidelines (will be prioritized based on input from AMITA, PMP, NarCAD training) Assessment Repeat visit about 8 wks following initial visit

Academic Detailers Mix of graduate students and current PharmD students PharmD students recruited through a competitive process Required to give 10 minute presentation on CDC Guidelines Evaluated on a number of criteria Train-the-trainer model 3-4 individuals attending NarCAD training session April 30 – May 1 Will train detailers based on NarCAD model

Dashboard Metrics Provider Level Metrics Number of prescriptions for controlled substances, by class Mean day supply per opioid prescription Mean MMEs per opioid prescription Rate of co-prescribing of opioids and benzodiazepines as a proportion of total number of opioid prescriptions Total number of MMEs prescribed Number of prescriptions with >31 day supply for opioids Proportion of opioid Rxs with MMEs ≥90 Proportion of opioid Rxs with MMEs between 50-90 Proportion of opioid Rxs with MMEs <50 Number of Rxs for long-acting/extended release opioids Number of naloxone Rxs

Timeline Visit 1 Visit 2 May June July August

Assessments Dashboard Metrics Physician administered survey after visit Detailer measures of perception of visit

Input from Advisory Committee Any previous experience with academic detailing? Interest in Expert panel? Input valued on Physician-completed survey Experience with PMP Attitude towards opioid prescribing Satisfaction with AD visit Detailer perception of AD visit Prescriber awareness of PMP and CDC guidelines Prescriber availability for visit Interest, courtesy, positive/negative attitude about visit Suggestions for implementation of Delta region ITV Experienced SIU faculty? Practicality of sending Chicago-area trained team?